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Interdisciplinary Approach and Personalized Therapy for Gynecological Disease

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Personalized Therapy and Drug Delivery".

Deadline for manuscript submissions: 20 December 2024 | Viewed by 13329

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Special Issue Editor

Dr. Aida Petca

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Guest Editor

Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
Interests: novel therapies; minimally invasive surgery; rare diseases; infertility

Special Issue Information

Dear Colleagues,

During their lifetime, women face a wide variety of health issues. It is becoming more and more evident that a single health specialist cannot always determine what the problem is and how to solve it. A multidisciplinary approach to women’s illnesses might be appropriate for managing complex cases.

Gynecological disorders present in various forms in every decade of life. We, as physicians, must be aware of these peculiarities at all times and seek explanations and solutions with the help of other specialties.

The aim of this Special Issue is to invite original research articles, notable clinical findings, and review articles that present and discuss the advancement of research and innovative therapies involving gynecological diseases from adolescence until menopause, the link between lifestyle choices and fertility, available interventions to subdue viral-borne disorders, and the relationship between disturbances in microbiota and gynecological disorders, as well as promising solutions arising from platelet-rich plasma and stem cell therapy. Various possible collaborations will make our era a turning point in modern medicine, providing hope even for apparently untreatable diseases.

Dr. Aida Petca
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

PRP treatment
menopause challenges
stem cell resources
SUI
fertility issues
personalized diagnosis
novel therapies

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Published Papers (7 papers)

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Research

Jump to: Review

13 pages, 233 KiB

Open AccessArticle

Gynecological Laparoscopic Surgeries under Spinal Anesthesia: Benefits and Challenges

by Attila L. Major, Kudrat Jumaniyazov, Ruslan Jabbarov, Mehdi Razzaghi and Ivanna Mayboroda

J. Pers. Med. 2024, 14(6), 633; https://doi.org/10.3390/jpm14060633 - 14 Jun 2024

Viewed by 1476

Abstract

Objective: This prospective study investigated the feasibility of performing laparoscopic pelvic surgery under spinal anesthesia and analyzed the intraoperative side effects, like pain, nausea, and vomitus, of 915 patients. Methods: The implementation and performance of laparoscopic surgery under local anesthesia on 915 patients (out of a total of 3212 who underwent laparoscopic pelvic surgery under spinal anesthesia) were analyzed in relation to BMI (body mass index), obesity, pain during surgery, amount of intraperitoneal mmHg CO₂ gas pressure, and surgical complications. Results: BMI > 30, intra-abdominal adhesions, increased duration of the operation, bleeding, and increased intraperitoneal CO₂ pressure were statistically significant as the main causes of pain during laparoscopic surgery under spinal anesthesia. Underweight patients, on the other hand, had less pain when intra-abdominal pressure increased compared to those of normal weight. The appearance of pain, nausea, and vomitus occurred in 10.3% of patients, and these events were easy to manage and treat. They did not affect the surgeon’s work or the course of the operation. Conclusions: In light of these observations, we are proposing spinal anesthesia for laparoscopic surgery as the first choice in patients who have no contraindications. To the best of our knowledge, this clinical study constitutes the largest clinical observation and dataset concerning spinal anesthesia in laparoscopic pelvic surgery. Trial registration: ISRCTN38987, 10 December 2019. Full article

(This article belongs to the Special Issue Interdisciplinary Approach and Personalized Therapy for Gynecological Disease)

19 pages, 5918 KiB

Open AccessFeature PaperArticle

A Comparative Analysis of Naïve Exosomes and Enhanced Exosomes with a Focus on the Treatment Potential in Ovarian Disorders

by Mohammad Mousaei Ghasroldasht, Farzana Liakath Ali, Hang-Soo Park, Morteza Hadizadeh, Shao Huan Samuel Weng, Allen Huff, Somayeh Vafaei and Ayman Al-Hendy

J. Pers. Med. 2024, 14(5), 482; https://doi.org/10.3390/jpm14050482 - 30 Apr 2024

Cited by 2 | Viewed by 1828

Abstract

Exosome-based therapy has emerged as a promising strategy for addressing diverse disorders, indicating the need for further exploration of the potential therapeutic effects of the exosome cargos. This study introduces “enhanced exosomes”, a novel type of exosomes developed through a novel cell culture system. These specific exosomes may become potent therapeutic agents for treating ovarian disorders. In this study, we conducted a comparative analysis of the protein and miRNA cargo compositions of enhanced exosomes and naïve exosomes. Our findings revealed distinct cargo compositions in enhanced exosomes, featuring upregulated proteins such as EFEMP1, HtrA1, PAM, and SDF4, suggesting their potential for treating ovarian disorders. MicroRNA profiling revealed that miR-1-3p, miR-103a-3p, miR-122-5p, miR-1271-5p, miR-133a-3p, miR-184, miR-203a-3p, and miR-206 are key players in regulating ovarian cancer and chemosensitivity by affecting cell cycle progression, cell proliferation, and cell development. We examined polycystic ovary syndrome and premature ovarian insufficiency and identified the altered expression of various miRNAs, such as miR-125b-5p and miR-130b-3p, for diagnostic insights. This study highlights the potential of enhanced exosomes as new therapeutic agents for women’s reproductive health, offering a detailed understanding of the impact of their cargo on ovarian disorders. Full article

(This article belongs to the Special Issue Interdisciplinary Approach and Personalized Therapy for Gynecological Disease)

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31 pages, 4329 KiB

Open AccessArticle

Assessing the Impact of Organ Failure and Metastases on Quality of Life in Breast Cancer Patients: A Prospective Study Based on Utilizing EORTC QLQ-C30 and EORTC QLQ-BR45 Questionnaires in Romania

by Andreea-Iuliana Ionescu (Miron), Alexandra-Valentina Anghel, Ionuț-Lucian Antone-Iordache, Dimitrie-Ionuț Atasiei, Cătălin-Alexandru Anghel, Andrei-Alexandru Barnonschi, Alexandra-Maria Bobolocu, Catinca Verga, Florica Șandru and Horia-Dan Lișcu

J. Pers. Med. 2024, 14(2), 214; https://doi.org/10.3390/jpm14020214 - 16 Feb 2024

Cited by 2 | Viewed by 2593

Abstract

Breast cancer (BC) significantly impacts the quality of life (QoL) of affected individuals. This study, conducted at Colțea Clinical Hospital, Bucharest, aimed to assess the impact of organ failures and metastases on QoL in breast cancer patients using EORTC QLQ-C30 and EORTC QLQ-BR45 questionnaires and the survival rate to understand the clinical journey and the quality of life status in breast cancer patients. From January 2019 to October 2022, a prospective, observational study surveyed 874 patients, revealing 201 fatalities, 66 refusals, and 607 eligible participants. Results indicated statistically significant differences in various QoL aspects for patients experiencing heart failure, including physical functioning, pain, insomnia, global health status, and overall summary score. Kidney failure exhibited significance in physical functioning for QLQ-C30 and body image, sexual functioning, and endocrine sexual symptoms for QLQ-BR45. Respiratory failure demonstrated significant differences across multiple QoL domains. Patients with bone metastases reported lower physical functioning (p = 0.006) and increased pain (p = 0.002). This study has revealed an overall 5-year life expectancy of 68.8%, with survival rates of 93.8% for Stage I, 86.3% for Stage II, and 77.2% for Stage III breast cancer. Metastatic cancer patients have shown a 35.6% survival rate over 45 months, with a median survival duration of 36 months. A significant limitation of our study was the administration of the questionnaire only once, preventing us from quantifying the impact of specific treatment types on quality of life. This study emphasizes the necessity of using standardized QoL assessments in clinical practice from the initial presentation to ongoing follow-up. Full article

(This article belongs to the Special Issue Interdisciplinary Approach and Personalized Therapy for Gynecological Disease)

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12 pages, 948 KiB

Open AccessArticle

Evaluating Patient Preferences and Clinical Outcomes in Stress Urinary Incontinence Treatment: A Short-Term Follow-Up Study of the Transobturator Tape Procedure and Pubourethral Ligament Plication (a Minimally Invasive Technique)

by Simona Brasoveanu, Răzvan Ilina, Ligia Balulescu, Marilena Pirtea, Cristina Secosan, Dorin Grigoraș, Flavius Olaru, Dragos Erdelean, Oana Balint, Mădălin-Marius Margan, Cristiana-Smaranda Ivan and Laurențiu Pirtea

J. Pers. Med. 2024, 14(1), 34; https://doi.org/10.3390/jpm14010034 - 26 Dec 2023

Viewed by 1194

Abstract

Objective: This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two surgical techniques for treating stress urinary incontinence (SUI): the transobturator suburethral sling (TOT) procedure and the pubourethral ligament plication (PUL) procedure. We evaluated the rates of postoperative complications, the duration of each procedure, hemoglobin loss, and days of hospitalization. Materials and Methods: This prospective study included 80 patients who underwent surgery for SUI: 40 patients for the TOT procedure and 40 patients for the PUL procedure. Clinical data on patient characteristics, treatment efficacy, and post-surgical outcomes were analyzed to assess patient preferences and real-world clinical effectiveness. Results: Regarding patient preferences, those who underwent TOT surgery were more likely to be older, had a higher average number of pregnancies, and were more often postmenopausal, in contrast to those who underwent PUL surgery (p < 0.001 for each comparison). TOT patients had a hospital stay on average of 1.02 days, while PUL patients benefited from ambulatory stays only. In addition, the TOT group had a significantly longer average operating time (16.80 min) compared to the PUL group (9.90 min, p < 0.001). The study revealed notable outcomes in both groups, with high cure rates for both TOT (N₁ = 33, 82.5%) and PUL (N₂ = 28, 70%) procedures. Specifically, 76.25% of the patients (61 out of 80) were cured after the procedures. Chronic pelvic pain was present in 3.75% of all patients and was notably only observed in the TOT group, with 3 (7.5%) cases being noted. Similarly, vaginal erosion was experienced by 5% of all patients, with 10% of patients in the TOT group and none in the PUL group being affected. Dyspareunia occurred in 2.5% of all patients, with there being two (5%) cases in the TOT group and none in the PUL group. Conclusions: This study highlights that while the PUL procedure achieves cure rates comparable to TOT, it offers a less invasive option with shorter operating times and no hospitalization required. These findings suggest that PUL could be a viable alternative for stress urinary incontinence (SUI) treatment, especially in contexts where avoiding mesh use is preferred. This adds significant value to patient-centered care in SUI management, offering tailored treatment options based on patient characteristics, preferences, and risk profiles. Full article

(This article belongs to the Special Issue Interdisciplinary Approach and Personalized Therapy for Gynecological Disease)

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Review

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14 pages, 994 KiB

Open AccessReview

Complications of Pelvic Prolapse Surgery Using Mesh: A Systematic Review

by Alexandru Dabica, Oana Balint, Flavius Olaru, Cristina Secosan, Ligia Balulescu, Simona Brasoveanu, Marilena Pirtea, Diana Popin, Ioana Flavia Bacila and Laurentiu Pirtea

J. Pers. Med. 2024, 14(6), 622; https://doi.org/10.3390/jpm14060622 - 11 Jun 2024

Viewed by 1533

Abstract

Background: Pelvic organ prolapse (POP) is a public health problem that influences millions of women around the globe, and it has a significant impact on the quality of life. From the FDA statement regarding the complications of using mesh implants in POP surgery to studies that have shown the benefits and side effects, we conducted a systematic review investigating the complications associated with surgical mesh implantation for POP repair. Methods: Relevant studies were identified through a comprehensive search of scientific databases. Studies evaluating the use of mesh in POP surgery and reporting on associated complications were included. Results: Among 2816 studies, 28 studies met the research criteria, with a total number of 8958 patients, revealing that in laparoscopic mesh surgery, the rate of mesh exposure was lower compared to vaginal mesh surgery, among other complications. Conclusions: Laparoscopic mesh surgery is superior as a long-term approach for POP repair compared to vaginal mesh surgery, offering lower complication rates and potentially better anatomical success. However, vaginal mesh surgery remains a valuable option for patients who are unsuitable for laparoscopy due to specific factors. Future research should explore alternative techniques, like pectopexy with or without mesh, to further improve surgical outcomes and patient experience. Full article

(This article belongs to the Special Issue Interdisciplinary Approach and Personalized Therapy for Gynecological Disease)

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16 pages, 419 KiB

Open AccessReview

The Impact of Laparoscopic Myomectomy on Pregnancy Outcomes: A Systematic Review

by Ligia Balulescu, Simona Brasoveanu, Marilena Pirtea, Dorin Grigoras, Cristina Secoșan, Flavius Olaru, Dragos Erdelean, Mădălin-Marius Margan, Alexandru Alexandru, Cristiana-Smaranda Ivan and Laurențiu Pirtea

J. Pers. Med. 2024, 14(4), 340; https://doi.org/10.3390/jpm14040340 - 25 Mar 2024

Cited by 1 | Viewed by 2178

Abstract

Study objective: The objective of this systematic review is to investigate the impact of laparoscopic myomectomy techniques on pregnancy outcomes, with a specific focus on the correlation between the type of suture used during the procedure and the incidence of uterine rupture. Additionally, the study aims to examine how the localization and size of myomas, key factors in laparoscopic myomectomy, may influence fertility outcomes. Data Sources: extensive searches were conducted using MDPI, PubMed, Web of Science, and Cochrane Library databases from 2008 to November 2023. Methods of Study Selection: The study involved women of reproductive age diagnosed with fibroids who underwent surgical removal of fibroids using either laparotomy or laparoscopy. The evaluation of pregnancy outcomes focused on indicators such as live birth rates, miscarriage rates, stillbirth rates, premature delivery rates, and cases of uterine rupture. Quality assessment was systematically performed by employing the National Institutes of Health Study Quality Assessment Tools, with the subsequent formulation of clinical recommendations that were meticulously graded in accordance with the robustness of the underlying evidence. Results: The pregnancy outcomes post-myoma treatment, as reflected in one of the presented tables, show a promising number of pregnancies and live births, but also indicate the potential risks of miscarriages and preterm births. The diversity in outcomes observed among various studies underscores the imperative for tailored patient care, as well as the necessity for additional research aimed at optimizing fertility and pregnancy outcomes following myoma treatment. Conclusion: This study offers insights into the criteria for patient selection and intraoperative methodologies specifically related to laparoscopic myomectomy. To enhance our understanding of the associations between fibroid characteristics (location, size) and reproductive outcomes, additional research is warranted, particularly through well-designed clinical trials. Full article

(This article belongs to the Special Issue Interdisciplinary Approach and Personalized Therapy for Gynecological Disease)

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18 pages, 339 KiB

Open AccessReview

Frontal Fibrosing Alopecia and Reproductive Health: Assessing the Role of Sex Hormones in Disease Development

by Alexandra-Maria Roman, Răzvan-Cosmin Petca, Mihai Cristian Dumitrașcu, Aida Petca, Andreea-Iuliana Ionescu (Miron) and Florica Șandru

J. Pers. Med. 2024, 14(1), 72; https://doi.org/10.3390/jpm14010072 - 5 Jan 2024

Cited by 2 | Viewed by 1836

Abstract

Frontal Fibrosing Alopecia (FFA) is a distinctive form of cicatricial alopecia characterized by gradual hairline recession, predominantly affecting postmenopausal individuals, thus implying a potential hormonal origin. This narrative review, spanning 2000 to 2023, delves into PubMed literature, focusing on the menopausal and hormonal status of women with FFA. The objective is to unravel the intricate nature of FFA and its plausible associations with hormonal dysregulations in women. While menopause remains a pivotal demographic characteristic linked to FFA, existing data suggest that its hormonal imbalances may not fully account for the development of FFA. Conversely, substantial evidence indicates a strong association between a reduction in fertile years, particularly through surgical interventions leading to an abrupt hormonal imbalance, and FFA in women. Additionally, exposure to hormone replacement therapy or oral contraceptives has shown varying degrees of association with FFA. Gynecologists should maintain a heightened awareness regarding the ramifications of their interventions and their pivotal role in overseeing women’s fertility, recognizing the potential influence on the progression of FFA. The recurrent theme of hormonal disruption strongly implies a causal connection between alterations in sex hormones and FFA in women. Nevertheless, this relationship’s extent and underlying mechanisms remain subjects of ongoing debate. Full article

(This article belongs to the Special Issue Interdisciplinary Approach and Personalized Therapy for Gynecological Disease)

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